Preoperative determination of susceptibility to malignant hyperthermia.

A careful individual and family history is of utmost importance in evaluating MH susceptibility. Patients having myopathy with or without a significant family history of MH must be suspected of having the condition. The initial evaluation should include routine blood studies and CPK determinations in addition to an electrocardiogram. Full evaluation differentiating rigid from nonrigid types must include a muscle biopsy for microscopic and contraction studies. Platelet ATP depletion with exposure to halothane shows promise as a prescreening test. Susceptible patients can be given both general and local anesthetics if the surgeon and support personnel have a thorough understanding of MH and if proper precautions have been taken and preparation of facilities has been made.